What is the significance of a 59-year-old male with low Hepatitis B (HB) surface antibody levels?

From the Guidelines

A 59-year-old male with low anti-hepatitis B surface antibody levels should receive a booster dose of the hepatitis B vaccine to ensure adequate protection against hepatitis B virus infection. According to the recommendations of the Advisory Committee on Immunization Practices 1, individuals with anti-HBs concentrations of <10 mIU/mL after the primary vaccine series should be revaccinated. The booster dose should be administered intramuscularly in the deltoid muscle, and antibody levels should be checked 1-2 months later to confirm an adequate immune response.

Key Considerations

• The standard adult dose of the hepatitis B vaccine is 20 mcg (1 mL) administered intramuscularly in the deltoid muscle.
• If antibody levels remain low after the booster, a complete revaccination series may be necessary, consisting of three doses given at 0,1, and 6 months.
• It's essential to rule out current or past hepatitis B infection by checking hepatitis B surface antigen and core antibody.
• Individuals with risk factors for hepatitis B exposure, such as healthcare work, multiple sexual partners, injection drug use, or household contacts with hepatitis B, should be prioritized for vaccination.

Testing and Follow-up

• Postvaccination serologic testing should consist of testing for anti-HBs and HBsAg 1-2 months after administration of the final dose of the vaccine series.
• Persons found to have anti-HBs concentrations of ≥10 mIU/mL after the primary vaccine series are considered to be immune, while those with concentrations of <10 mIU/mL should be revaccinated.
• Immunocompromised persons might need annual testing to assess anti-HBs concentrations, while immunocompetent persons have long-term protection and do not need further periodic testing to assess anti-HBs levels 1.

From the FDA Drug Label

Immunogenicity in Healthy Adults and Adolescents: Clinical trials in healthy adult and adolescent subjects have shown that following a course of 3 doses of 20 mcg ENGERIX-B given according to the ACIP-recommended schedule of injections at months 0,1, and 6, the seroprotection (antibody titers ≥10 mIU/mL) rate for all individuals was 79% at month 6 and 96% at month 7; the GMT for seroconverters at month 7 was 2,204 mIU/mL. Immunogenicity in Older Subjects: Among older subjects given 20 mcg at months 0,1, and 6, the seroprotection rate 1 month after the third dose was 88% However, as with other hepatitis B vaccines, in adults over 40 years of age, ENGERIX-B vaccine produced anti-HBs titers that were lower than those in younger adults (GMT among seroconverters 1 month after the third 20-mcg dose with a 0-, 1-, and 6-month schedule: 610 mIU/mL for individuals over 40 years of age, N = 50)

The patient is a 59-year-old male with low anti-hep B surface antibodies.

• Booster dose: The FDA label does not provide guidance on booster doses for individuals with low anti-hep B surface antibodies.
• Vaccine response: Adults over 40 years of age may have lower anti-HBs titers after vaccination. Given the patient's age and low anti-hep B surface antibodies, re-vaccination or a booster dose may be considered, but the FDA label does not provide direct guidance on this specific scenario 2.

From the Research

Hepatitis B Vaccination Recommendations

• The Advisory Committee on Immunization Practices recommends universal HepB vaccination for adults aged 19-59 years, including pregnant persons, and adults aged ≥60 years with risk factors for hepatitis B 3.
• Adults aged ≥60 years without known risk factors for hepatitis B may also receive HepB vaccines 3.
• Three safe and effective vaccines are available in the United States and other countries for HBV prevention, and the benefits of vaccination in preventing infection and its sequelae have been substantiated 4.

Importance of Hepatitis B Vaccination

• Hepatitis B virus (HBV) is highly infectious, with over 292 million chronically infected people worldwide and up to 2.4 million in the United States 4.
• HBV has the heaviest public health burden of all hepatitis viruses and has now surpassed other major communicable diseases as a leading cause of death globally 4.
• Preventing transmission is essential, and efforts are in place to reinforce screening, vaccination, and routine follow-up 4.

Vaccination for Immunocompromised Patients

• A rational approach to the problem of hepatitis B in immunocompromised patients provides for the evaluation of HBV markers and of liver condition in all subjects starting immunosuppressive therapies 5.
• Pre-emptive use of antivirals is recommended in inactive carriers, especially if they are undergoing immunosuppressive therapies judged to be at high risk 5.
• Pre-emptive therapy by HBV nucleos(t)ide analogues should be considered for all HBV-infected patients with immune deficiency 6.

Low Anti-Hep B Surface

• There is no direct information provided in the studies regarding the specific situation of a 59-year-old male with low anti-hep B surface.
• However, the studies emphasize the importance of hepatitis B vaccination and the need for evaluation and potential treatment in certain cases, such as immunocompromised patients 5, 6.